title: Biomechanics of the monopedicle skin flap.
abstract: OBJECTIVE
  The design and implementation of skin flaps remains a puzzle for the reconstructive surgeon. The objective of the present study is to use finite element (FE) analysis to characterize and understand the biomechanics of the monopedicle skin flap design.
  
  
  METHODS
  The current study uses a nonlinear hyperelastic FE model of the human skin to understand the biomechanics of monopedicle-based flap designs as geometric flap parameters are varied.
  
  
  METHODS
  In silico.
  
  
  METHODS
  The simulation included the displacement loading, stitching, and relaxation of various forms of the flap design. Stress and strain outcomes, previously correlated with scarring, necrosis, and blood perfusion, are reported for a basic monopedicle design as well as a number of modifications to this design.
  
  
  RESULTS
  The results suggest that the length of the monopedicle flap should not exceed 3 times the size of the defect, as the benefit in reducing principal strain (deformation) is diminished beyond this point. Further, to minimize skin strain, the ideal Burrow's triangle size can be described as proportional to flap length and inversely proportional to defect height, according to a linear function.
  
  
  CONCLUSIONS
  The ideal flap design should attempt to minimize not only the stress in the skin, but the size of the incisions and the degree of undermining. The results of our analyses provide guidance to increase the general understanding of monopedicle flap mechanics and provide context for the clinician and insight into designing a better monopedicle flap for individual situations.
authors.affiliation: Exponent Inc, Menlo Park, California, USA.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Lovald
authors.forename: Shelby G
authors.initials: SG
authors.lastname: Topp
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Ochoa
authors.forename: Curtis W
authors.initials: CW
authors.lastname: Gaball
mesh_terms: D001696:Biomechanical Phenomena; D020342:Finite Element Analysis; D006801:Humans; D012867:Skin; D013524:Surgical Flaps
keywords: advancement flap; biomechanics; finite element analysis; monopedicle; skin flap